Provider Demographics
NPI:1114124955
Name:MALIBU LOVE & CARE HEALTHCARE AGENCY INC
Entity Type:Organization
Organization Name:MALIBU LOVE & CARE HEALTHCARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-362-3831
Mailing Address - Street 1:1468 S PALM AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5520
Mailing Address - Country:US
Mailing Address - Phone:954-362-3831
Mailing Address - Fax:
Practice Address - Street 1:1468 S PALM AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-5520
Practice Address - Country:US
Practice Address - Phone:954-362-3831
Practice Address - Fax:954-362-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992636251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101778500Medicaid